Stop treating dementia with antipsychotics: CARP

Wanda Morris, VP of Advocacy for CARP was featured as a Guest Columnist in the Toronto Sun highlighting a serious issue affecting dementia patients. Here’s an excerpt of the column:

January 6, 2017, TORONTO – Right now, 88 out of 100 long-term care patients suffer from dementia and only one in 10 possesses full cognitive abilities. In recent years, the composition of LTC residents with dementia has risen markedly. LTC funding has not.

Whether through funding shortfalls or the competing priorities of providing great care and making a profit, there is another tragedy playing out right now across the province: The use of antipsychotics as chemical restraints.

If you have a psychosis, you will likely be prescribed antipsychotics. That is completely appropriate.

But in many long-term care facilities, antipsychotics are being used for patients living with dementia.

Statistics compiled by Health Quality Ontario reveal that in 2015, an average 27.3% of residents in long-term care facilities were given anti-psychotics even though they did not suffer from a psychosis.

Antipsychotics are serious drugs with significant side effects. They increase the risk of stroke, heart disease, diabetes, pneumonia, falls and death.

They also impact quality of life and make it difficult for residents to communicate with loved ones.

Why are these drugs so frequently prescribed?

Individuals with dementia can be difficult to handle and many LTC facilities are understaffed. Provincial staffing ratios, established when far fewer patients had dementia, are no longer sufficient.

In privately-owned facilities, personal support workers describe situations in which management does not fill in for sick staff, leaving those on duty with impossible workloads.

There is no excuse for the indiscriminate administration of antipsychotics to dementia patients. Facilities should first attempt to address difficult behaviour without drugs. Ensuring a patient’s comfort can significantly reduce behavioural symptoms and decrease the need for antipsychotics.
The health-care system needs to invest in specialized support workers who can provide care for residents with varying stages and types of dementia.

For years, Ontario’s health ministry has heard about the system’s failings from their stakeholders. The Ontario Long Term Care Association, which represents 70% of the province’s 630 long-term care homes, says that too many seniors aren’t getting the support they need, particularly those with dementia.

CUPE, which represents many of the workers inside long-term care facilities, says provincial under funding leaves residences without enough staff to provide the care needed to allow residents to live with dignity.

The status quo is a powerful thing and there are facilities and health-care professionals who are unwilling, or perhaps unable, to change their view on the necessity of antipsychotics.